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Organization
SPARK CHANGE WELLNESS CENTER, LLC
Active
Organization
SPARK CHANGE WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE MACK PHD (PSYCHOLOGIST)
(302) 898-1720
Entity
Organization
Contact information
Practice address
331 GAMBRILLS RD STE 4B, GAMBRILLS, MD 21054-1141
(410) 864-0201
Mailing address
331 GAMBRILLS RD STE 4B, GAMBRILLS, MD 21054-1141
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/22/2026
Last updated
09/22/2026
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